Improving Swallow Ability with sEMG and Exercise

Patient Information: Male, Age 65

Diagnosis: Stroke / Oropharyngeal Dysphagia

History: This gentleman was admitted to a skilled nursing facility for rehabilitation services following hospitalization due to a stroke. He was diagnosed with oropharyngeal dysphagia (difficulty swallowing). His swallow initiation was inconsistent and he had difficulty managing his own secretions. He could not take any food or liquid by mouth and a feeding tube was placed. Prior to his stroke, he ate a regular diet.

Pre-Therapy Status:

• Clinical Swallow Assessment: Unable to initiate a swallow upon command and was unable to manage his saliva. Speech intellegibility (ability to be undersood) impaired with slurred speech.
• Functional Oral Intake Scale (FOIS): Level 1; nothing by mouth.
• Instrumental Swallow Assessment with Modified Barium Swallow Study (MBSS): Exhibited poor coordination of the swallow with premature spillage that resulted in aspiration (material entering airway) of all consistencies presented. Nothing by mouth (NPO) was recommended.
• Diet: All nutrition and hydration were delivered through the feeding tube.

Therapy Information:

• Modality: OmnisEMG™ Biofeedback.
• Frequency: 5x per week.
• Protocol Specifics: Typical swallows performed with ice chips to work on swallow initiation using Synchrony sEMG biofeedback with the trace display and bow and arrow visualizations. Treatment progressed to effortful swallows with bar graph visualization using nectar thick consistency with progressive challenge of increasing liquid thickness and volume.
• Duration: Three weeks.
• Other Therapy Services Provided: Thermal stimulation to facilitate swallow initiation.

• Clinical Swallow Assessment: Consistent initiation of a swallow following intake of food and liquid, and manages saliva. Speech intelligibility greatly improved.
• FOIS: Level 5; total oral diet with multiple consistencies but requiring special preparation or compensations.
• Instrumental Swallow Assessment: Follow up MBSS showed improved swallow coordination and timing to be within functional limits, resulting in no aspiration of any consistencies.
• Diet: Mechanical soft with thin liquids.